S Hirsch, T Solari, R Rosen. JPGN 2022; 74: 419-423. Effect of Added Free Water to Enteral Tube Feeds in Children Receiving Commercial Blends

This retrospective study (n=45) shows that supplemental water added to blenderized tube feeds may have detrimental effects.

Key finding:

• Patients receiving <20% thin liquids were less likely to undergo chest X-rays during follow-up than patients receiving larger amounts of thin liquids (10% in the minimal thin group versus 48% in the greater thin group, P = 0.03)
• This relationship remained significant after controlling for underlying pulmonary disease, aspiration, method of feed administration (bolus or continuous feeds), fundoplication status, and oral intake status. CXRs likely indicate concern for pulmonary outcomes related to feedings.

My take: Many thick formulas may be difficult to administer via GT. However, using too much water may hinder the benefits of a blenderized diet. Larger prospective studies are needed to determine optimal viscosity diets in these vulnerable populations.

The Boston group has several related articles (Thanks to Alison Miller for sharing these articles):

B Hron et al. J Pediatr 2019;211:139-45. Health Outcomes and Quality of Life Indices of Children Receiving Blenderized Feeds via Enteral Tube

• Blenderized diets were associated with decreased healthcare use, improved symptom scores, and increased patient satisfaction compared with conventional formulas.

B Hron, R Rosen. JPGN 2020; 70: e124–e128. Viscosity of Commercial Food-based Formulas and Home-prepared Blenderized Feeds

• This article shows that adding 90 mL of water can reduce viscosity of blenderized formula from >6000 cP to ~1000 cP. The authors suggest that those patients with significant reflux may benefit from higher viscosity formulas: “Low viscosity formulas such as Kate Farms and Compleat may not be ideal for patients fed via gastrostomy with significant reflux, in whom extremely thick or possibly moderately thick liquids may have a beneficial impact.”
• Commercial food-based formulas vary even more widely, with some meeting
  criteria for thin liquids (Kate Farms Pediatric 1.2 and Compleat Pediatric), slightly thick (Harvest), mildly thick (Nourish), moderately thick (Compleat Organic Blends, Liquid Hope), and extremely thick (Real Food Blends).

Specific viscosity (cP) listed in Table 1 of this article:

• Pediasure 1.0 19
• Kate Farms Pediatric 1.2 104
• Pediasure 1.0 with 1 tsp/oz rice 438
• Nourish 1363
• Harvest 1774
• Liquid Hope 2202
• Compleat Organic blends (chicken) 4864
• Real food blends (Quinoa, Kale, Hemp) 6331